ABSTRACT
This chapter presents a systematic approach to managing a critically ill or injured child whilst awaiting a tertiary retrieval team. There are 34 Paediatric Intensive Care Units (PICUs) in the UK reflecting centralisation of specialist care. In 2014, 6000 children required transferring to a hospital with a PICU and 77% of them were transferred by a specialist paediatric intensive care and retrieval team. Paediatric physiological parameters vary with age. The goal of the management is to stabilise the child by securing the airway, ventilating effectively and ensuring a well-filled circulation, in preparation for transfer to PICU. The main indications for intubation include apnoea, decreased respiratory drive, ineffective respiration, lung failure, and airways obstruction, to reduce the work of breathing in a critically ill child with septic shock or cardiac failure. Paediatric airways are positionally anterior compared with the adult.
